Doctors Lounge - Neurology Answers
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Forum Name: Neurology Topics
Question: Optic Disc Drusen
|LMC2690 - Sun Jul 25, 2010 11:57 am||
My mother was diagnosed with Optic Disc Drusen serveral years ago. She has had peripheral loss in both eyes for some time now, but her vision hasn't changed much since then. She woke up this morning with complete vision loss in her left eye. I want to know if she could regain the vision back or are there any treatments out there that can help her. She's only 47 years old. Please let me know if I can do anything for her. Thank you.
|Dr.M.Aroon kamath - Mon Aug 30, 2010 2:41 am||
Optic Nerve Head Drusen (ONHD) are often incidentally discovered findings during routine eye testing. Drusen are depositions of mucopolysaccharides and proteinaceous material that get deposited in front of the lamina cribosa within the optic nerve head. Disturbance in the axonal metabolism, coupled with a small scleral canal is considered responsible for the development of Drusen.They are more commonly seen among Caucasians and are believed to have an autosomal dominant pattern of inheritance with incomplete penetrance. Bilateral distribution is seen in 75-85% of affected individuals.
There are two main types of ONHD:
- "visible" drusen, and
- "buried" drusen. Buried drusen are often found in the pre-teen children.
As the optic disc may appear to lack an "optic cup", resulting in an appearance resembling papilledema, from which it needs to be differentiated. As affected individuals get older, particularly past the teenage years, the drusen become more obvious due to continuing calcium deposition. The drusen begin to bulge from the edge of the optic disc and cup ("lumpy-bumpy" appearance), especially on the inferior nasal side, causing visual field defects (in particular, the "nasal step defects"). Goldmann Visual Fields (GVF) may also reveal other defects such as, enlargement of the blind spot with or without constriction of the peripheral fields, and small peripapillary scotomas.
Apart from the visual field defects, drusen may be associated with
- glaucoma, and
- vascular complications (anterior Ischemic Optic Neuropathy, choroidal neovascularization, central retinal artery occlusion, and central retinal venous occlusion).
It is extremely important to differentiate optic disk drusen from papilledema in order to avoid unnecessary neurological examinations, but also, not to miss genuine neurologic disorders.
Glaucoma as a cause of the peripheral field loss must also be excluded. Intraocular pressures are elevated in most types of glaucoma but, may be normal in some cases.Thus, the distinction between glaucomatous damage and benign ONHD is not always so straitforward. Patients with ONHD should undergo regular testing of visual fields, intraocular pressures (IOP), and nerve fiber layer examinations. In patients with deteriorating visual fields and borderline IOP, antiglaucomatous therapy is frequently recommended.
Choroidal neovascularization in younger patients is associated with a much better prognosis than in adults. In younger patients, resolution will occur with mild to moderate visual symptoms. Most cases of subretinal neovascularization associated with ONHD resolve sponteneously. Laser photocoagulation should only be considered in cases if central visual acuity is threatened.
It is not clear what exactly precipitated the acute total loss of vision in the instance of your mother. It is also not clear if she has drusen in one or both eyses and what her IOPs are. All these must be urgently and comprehensively investigated. More importantly, prevention of complications in the other eye is a priority.
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